Blog: improving nutritional care and oral nutritional supplement prescribing for adults in the community

Susan Sheridan, dietitian

“Malnutrition – it’s one of the hidden problems in our society. When a person is malnourished it has an effect on many other aspects of their health and wellbeing. A typical example I see is malnutrition causing frailty. When a person is frail, they are more at risk of falling, consequently they are more likely to end up in hospital with complications.

Here in Bradford, we wanted to change the perception of malnutrition so that it is identified and treated in a way that means that we are giving the right care, in the right place at the right time.

Therefore, the two CCGs in Bradford funded a two year pilot project to look at how we can improve malnutrition care and oral nutritional supplement (ONS) prescribing for adults in the community. This involved setting up a malnutrition project team to works across the different health and care organisations in Bradford.

The project team started by looking at the main areas of concern around malnutrition. We knew that prescribed oral nutritional supplements are clinically effective and cost effective in treating disease related malnutrition. However, there is an issue – locally and nationally – around whether the use of ONS is appropriate and effective. This relates to medicines waste, through people receiving medicines and not taking them as directed, and the increasing costs of prescribing.

But prescribing costs were just one side of the coin. We wanted to look at the full process, from how malnutrition is actually identified through to reviewing and monitoring.

The project group worked in consultation with clinical leads and patient representatives to develop a new malnutrition care pathway using a template on our clinical IT system, SystmOne. It was clear that although our clinicians felt that they weren’t experts in nutrition and that they wanted clear straightforward guidance from which they could build and develop their knowledge. Getting their clinical feedback was imperative to getting the template right. We made sure that it clearly details a step-by-step approach from the all important first step of identification and screening through to monitoring. The template contained links to information leaflets, websites and local specialist services. It also helps address concerns around prescribing with a limited ONS formulary which helps clinicians prescribe the right supplement if it is needed.

It does take time and a lot of legwork, but it is worth it! I am currently going out to our GP practices to meet with staff and show them how to use the template. The feedback has been really positive so far. GPs say how much better it is to identify patients who need to be screened for malnutrition, they say the template is easy to use and has become almost like a portal for essential information and best practice. Patient feedback has also been fantastic, they appreciate having the support of a dietitian who can give personalised advice.

The template has been used for about six months now and one of our next steps is to do a more formal evaluation of its use. But even in this short time we can see that it is already reducing prescribing costs around ONS which also indicates that people are benefitting from a ‘food first’ approach, receiving better advice and guidance around nutrition.

I really have a passion for promoting improved nutritional care to patients and the need to identify those at risk early so having the chance to work on this project has been fantastic. It’s great to hear such positive feedback and I’m excited to see the benefits that this will bring to our patients for the future.”

About Susan

Susan Sheridan has worked as a specialist community dietitian for Bradford Teaching Hospitals NHS Foundation Trust for 12 years, primarily visiting patients in their homes to tackle malnutrition and witnessing first-hand the effects the condition can have. She has a passion for promoting improved nutritional care to patients and early identification of those at risk of malnutrition.